Provider Demographics
NPI:1073784963
Name:MEDIDON, LLC
Entity Type:Organization
Organization Name:MEDIDON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT
Authorized Official - Phone:408-331-5196
Mailing Address - Street 1:333 COBALT WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-5402
Mailing Address - Country:US
Mailing Address - Phone:408-331-5196
Mailing Address - Fax:408-328-8201
Practice Address - Street 1:333 COBALT WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-5402
Practice Address - Country:US
Practice Address - Phone:408-331-5196
Practice Address - Fax:408-328-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00002005332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies